PVN Customer Information Sheet

Date

Company Name

Company Phone Number

Area CodePhone Number

Company website

Mailing address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Shipping address same as mailing address?

Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Federal Tax ID Number

Financially Responsible Party*

First NameLast Name

Financially Responsible Party's Phone Number*

Area CodePhone Number

Financially Responsible Party's Email Address

example@example.com

Authorized buyer*

First NameLast Name

Authorized Buyer Phone Number

Area CodePhone Number

Authorized Buyer Email Address

example@example.com

Other Authorized Buyers, Full Names

Accounts Payable Contact*

First NameLast Name

Accounts Payable Phone Number

Area CodePhone Number

Accounts Payable Email

example@example.com

Preferred method to receive invoices:

Should we charge you sales tax?

Sales Tax Exemption Number (if none, type N/A)

Include state of issue.

*Dealer or Grower's License Number

Include state of issue.

*A dealer's or grower's license number is required by the Nebraska Department of Agriculture if you intend to resell/redistribute nursery stock. If you intend to resell or redistribute and do not have a Dealer’s/Grower’s License, we cannot sell to you! To obtain a Nebraska license, contact Julie VanMeter at the NDA at 402-471-2394. (If you are the final customer, i.e. planting on your own property, like an apartment comlex or other commercial property, the license is not necessary.)

Payment is required upon receipt of plant material until a credit application has been completed and approved. We accept cash, check, Visa, MasterCard, American Express, and Discover Card. A 3% surcharge will be applied to all credit card payments. Past due accounts are subject to a 1.5% finance charge per month. We look forward to doing business with you!

Please send me email updates from Papio Valley Nursery.

Weekly/Biweekly during the busy season. Less often in off-season.